I. Introduction/General Information A. Thyroid 1. Endocrine gland a. Lobes are cone shaped b. Apex extends to oblique line of thyroid cartilage 2. Highly vascular
3. Anterior & lateral to larynx, trachea 4. Lobes connected by an isthmus 5. Pyramidal lobe may be present 6. Normally not palpable
Located in the anterior region of the neck This gland has an accessory (pyramidal) lobe
B.
Parathyroid glands
1. Usually four two on each side (2-8 is normal) 2. Lie on the posterior surface of thyroid 3. May be embedded within thyroid gland 4. Regulate calcium/phosphate levels 5. Required for life
Parathyroid Glands are located on the posterior aspect of the thyroid; sometimes the tissue is embedded within thyroid tissue.
II. Detailed Anatomy A. Thyroid 1. Largest endocrine gland in adult 2. Normally extends from ~ C-5 through ~ T-1 3. Highly vascular
5. Pyramidal lobe a. present in ~ 33% of population. b. Extends upward from isthmus c. anterior to thyroid cartilage
Pyramidal Lobe
c. Lobes:
1. Attached to cricoid cartilage by ligaments 2. Medial surface adapted to larynx and trachea
d. Isthmus
1. 1.25 cm x 1.25 cm 2. Crosses @ tracheal rings ~2-4 3. Occasionally absent
6. Highly vascular gland supplied by four large arteries a. R & L inferior thyroid artery b. R & L superior thyroid artery
7. Drained by R & L superior, middle and inferior thyroid veins a. Veins arise from plexus b. on anterior surface of gland c. Extend over anterior surface of trachea
Inferior Thyroid Vein
d. Lymph vessels
1. In interlobular connective tissue between lobes 2. Connect with network in wall of gland 3. terminate in thoracic and right lymphatic ducts
8. Muscular landmarks
a. Sternocleidomastoid muscles lie laterally b. Longus colli (prevertebral) muscles lie posteriorly c. Strap muscles lie anteriorly
Strap Muscles
9. Autonomic innervation via a. Cervical portion of sympathetic trunk b. Parasympathetic fibers arise from Vagus X
9.
Treatment considerations
a. Superior thyroid artery is accompanied by superior laryngeal nerve b. Inferior thyroid artery is accompanied by recurrent laryngeal nerve
c. Damaging nerves results in partial or total paralysis of larynx d. Bordered by neurovascular structures contained in carotid sheath
B. Parathyroid glands 1. Yellow-brown 2. ovoid or lentiform structures 3. weigh ~ 50 mg each 4. Measure 3-10 mm x 2-6 mm x 1-4 mm
Ultrasound useful in differentiating cystic from complex or solid masses Thyroid Cysts 1. Typical cystic appearance 2. Colloid cysts 3. Thyroglossal duct cysts
Pathology, cont
3. Branchial cleft cysts a. More specific than pattern for other neoplasms
Pathology, cont
C. Structures of Carotid Sheath 1. Jugular vein, carotid artery 2. Delineate lateral aspect of thyroid 3. Jugular vein lateral to carotid artery a. vein has greater diameter b. Is distensible on valsalva maneuver
F. Parathyroids are difficult to see 1. Size and location are variable 2. Usually: a. moderately echogenic
b. c. d. e. well-circumscribed capsule around anterior to longus colli medial to common carotid a.
Parathyroids, continued
3. Longus Colli (prevertebral) Muscles a. Attachments: 1. O = cervical vertebrae 2. I = cervical vertebrae b. Action: twists, bends neck c. Lie posterior
a. Contains thyroglobulin
b. May have hemorrhagic center
c. May be aspirated
3. Thyroglossal Duct Cyst a. Lies @ midline b. Represents non-closure of thryoglossal duct c. Congenital anomaly:
1. retention of tract 2. between thyroid and foramen cecum
d. Usually surrounded by hyoid bone e. More frequently diagnosed in pediatric age groups
f. may be asymptomatic
Thyroid, continued
Thyroid, continued
i. Treatment:
1. excision of cyst & central hyoid bone
2. < 1% accompanied by cancer
j.
1. Adenoma
a. Well-encapsulated
b. Usually solitary
c. Homogeneous
Note atrophy of the left lobe with the tumor protruding from it Right lobe may hypertrohy to compensate for loss of function in L. lobe
Thyroid, continued
3. Goiter
Goiter, continued
Types of Goiters
D. Parathyroid Diseases 1. Benign adenoma a. Relatively common b. usually results in hyperparathyroidism 2. Cancers are rare 3. Surgical excision gives > 90% cure rate
Parathyroid Diseases
Pathogenesis of Hyperparathyroidism
PTH increases blood calcium levels Acts on bone, kidneys, small intestines
Hyperparathyroidism